Depression Among Individuals with Hearing Impairment

Background and Purpose: One of the adverse effects of hearing impairment is elevated depressive symptoms as hearing difficulties impede social participation of affected individuals. This study examines whether the effects of hearing impairments on depression are mediated through increased restriction in social engagement and whether these mediating relationships are different by age group: middle-aged (45-64) vs. older (65+) individuals.

Methods: This study analyzed 3,474 individuals aged 45 and older from the 2017-2018 National Health and Nutrition Examination Survey. A multiple-group path analysis was conducted to compare middle-aged individuals (n=1,974) and older adults (n=1,499) while simultaneously controlling for the effects of other covariates. Hearing impairment was measured as whether an individual had serious difficulty hearing (yes/no). Social participation restriction (0-6) was measured as whether a respondent had difficulties in participating in (1) social activities (e.g., visiting friends, attending clubs/meetings) and (2) going out to things like shopping, movies, or sporting events. Depressing was measured with the Patient Health Questionnaire-9 (PHQ-9). Covariates included self-rated health, vision difficulty, age, marital status, and gender.

Results: Among U.S. individuals aged 45 or older, 12.9% reported having serious difficulty hearing. As expected, the prevalence was much higher among older adults (22.3%) than among middle-aged individuals (7.5%). In both age groups, significant direct effects between hearing impairment and depression, as well as indirect effects via social participation restriction, were found (p<.05). Namely, hearing impairment was directly associated with a higher level of depressive symptoms (i.e., significant direct effect), and individuals with hearing impairment were more likely to experience social participation restriction, which in turn was associated with greater depressive symptoms (i.e., significant indirect effect). Regarding moderated mediation, a significant difference between the two age groups was found in the relationship between restricted social participation and depression: The effect of restricted social participation on depression was greater among middle-aged adults than among older adults (p<.001).

Conclusions and Implications: These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for middle-aged adults. As the importance of social engagement was greater among middle-aged adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.